New study links 2023 Maui wildfire to spike in suicide, overdose

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New study links 2023 Maui wildfire to spike in suicide, overdose

Deaths by suicide and drug overdose significantly increased in the aftermath of the August 2023 Maui wildfire, according to a new study published in the Journal of the American Medical Association (JAMA).

The study, led by Alex Ortega, dean of the Thompson School of Social Work and Public Health, and Keawe‘aimoku Kaholokula, chair of the Department of Native Hawaiian Health, in the John A. Burns School of Medicine, both at the University of Hawaiʻi at Mānoa, along with Jonathan Purtle, associate professor at New York University’s School of Global Public Health, is one of the first to show that wildfires can lead to immediate deaths from suicide and drug overdose. 

"Nationally and globally, we have seen an increase in devastating wildfires, and these fires can have a tremendous impact on the health and well-being of communities,” said Ortega. “Public health must be adequately prepared to respond to serious mental health consequences of wildfires and other climate-related disasters that are increasing in both frequency and severity." 

Death rates increased statewide

The researchers analyzed death records from all of Hawai‘i’s counties from 2014 through 2023, focusing on suicides and drug overdoses. They compared the death rates before, during and after the wildfires.

The study showed that in August 2023, suicide and overdose death rates increased by 46% statewide. However, the impact was much greater in Maui, where there was a 97% increase in suicide and overdose deaths compared to prior months. When limiting their analysis to just suicides in August 2023, they found that the suicide rate was 182% higher in Maui than other islands in the state.

“Prior research has found similar effects in the months after wildfires and other disasters. But the immediacy of the effects on suicide rates that we observed in Maui are unique and troubling,” said Purtle.

Researchers suggest that both direct exposure to the wildfires and indirect effects, such as concern for loved ones, may have contributed to the rise in death rates. The findings also show that residents who fled Maui for other islands could have contributed to the increase in state-wide suicide and overdose deaths.

In an earlier study led by the UH researchers, the team documented a 41% rise in 988 Lifeline calls after the Lahaina wildfires, exposing critical gaps in Hawaiʻi’s mental health infrastructure.

A call to action 

This recent study emphasized the importance of early behavioral health intervention during disaster responses and recommends including suicide and overdose prevention in wildfire response and recovery plans.

Kaholokula noted disaster recovery must address more than just rebuilding physical infrastructure. “Plans should also focus on the psychological and emotional impacts communities face—including hopelessness, cultural disconnection and stigma,” he said. “There needs to be a plan for suicide and substance abuse prevention, and other mental health support.”

The study used the most recent death data available from the CDC. Researchers will use 2024  data when it becomes available to see if there is was an increase in suicides and/or overdoses over the course of 2024, as more time elapsed since the wildfires. 

This study is part of the NIH-funded Maui LOA (Learnings to Overcome Adversities) project, a five-year effort led by UH researchers to understand how disasters like the Lahaina wildfires affect community, healthcare, and emergency response system resiliency. The research focuses on vulnerable populations and aims to strengthen health system resilience and improve access to care.
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Link to soundbites (details below): 
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SOUNDBITES:

Alex Ortega, UH Thompson School of Social Work & Public Health Dean

(18 seconds)
This is really a call for increasing mental health services capacity in Hawaiʻi in general, but more specifically in Maui, because even a year after the wildfire or two years after now, we're still seeing devastating mental health impacts as a result of the wildfire.

Keawe‘aimoku Kaholokula, JABSOM Dept. of Native Hawaiian Health Chair

(19 seconds)
“It’s a significant event that takes a significant toll on our communities emotionally, physically, financially, and we do need to better understand and learn from these experiences so we can do a better job of mitigating these impacts in the future through policies and practices.”

Jonathan Purtle, New York University Public Health Associate Professor

(14 seconds)
“What we found was that the highest suicide and overdose death rate in that 10 year period occurred in Maui and also in other Hawaiian islands. It was the highest in the same month as the wildfires in August of 2023.”

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